Suicidal ideation has less power when it is verbalised. — Fran Houston
To mark World Suicide Prevention Day our book High Tide Low Tide: The Caring Friend’s Guide to Bipolar Disorder will be free on Kindle between September 10–14, 2023.
Established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organisation, World Suicide Prevention Day (WSPD) is observed each year on September 10. The theme for WSPD 2021–2023 is Creating Hope Through Action. According to the World Health Organisation, this “serves as a powerful call to action and reminder that there is an alternative to suicide and that through our actions we can encourage hope and strengthen prevention. By creating hope through action, we can signal to people experiencing suicidal thoughts that there is hope and that we care and want to support them. It also suggests that our actions, no matter how big or small, may provide hope to those who are struggling.”
That sounds great, but what can we possibly do as individuals to help someone thinking about ending their life? What difference can we make? In this post I’m going to focus on one way we can all contribute to keeping each other safe, which is by having open conversations about suicide and suicidal thinking.
The Power of Conversation in Suicide Prevention
According to suicide prevention charity Grassroots, approximately 120 people die by suicide every week in the UK. One in five people in the UK have suicidal thoughts and one in twenty will attempt suicide. Statistics such as these can be hard to grasp, but there will be people in your life — your friends, family, neighbours, and colleagues — with direct experience of suicidal thinking. You might not know who or how many, and it’s not a comfortable realisation, but it’s the simple truth. Many of my friends have had, or still have, thoughts of suicide. Some have made attempts to end their life. Others have not. I know this because it’s not a taboo subject for us and comes up in conversation whenever it needs to.
Whether it’s talking someone out of a dangerous situation, helping to counter the stigma of suicidality, or holding space for a friend or loved one to share what they’re going through, talking matters. Listening matters even more. Conversations can literally be the difference between despair and hope, between death and life. Fran expresses this well in the epilogue to our book.
It’s true when I say I would be dead if Marty hadn’t come along. So much hurt, so much pain, so much rejection, it made no sense to stay. [...] Friends like Marty who are willing to be with me in the darkness are the ones who give me light. Yes there are medications. Yes there is therapy. Yes there is personal responsibility. But caring friendship is the best medicine of all. Then life begins to have purpose.
She ends with a call to action that captures the essence of WSPD for me. “Stick around. It may not be easy but you can help someone make a life worth living. Maybe even save a life.”
Overcoming the Fear of Discussing Suicide
There are many reasons someone might not want to talk about their mental health but there are also reasons we may hesitate to open a conversation with someone who’s struggling or feeling suicidal. The most obvious of these is fear. It’s scary to hear someone we care about tell us they have thoughts of hurting themself or putting their life at risk. Once someone has shared that with us — and doing so represents a huge leap of trust on their behalf — there’s no way to unhear it. There’s no shame in admitting we feel afraid to go there. It’s an important step towards overcoming those fears, or setting them aside for the moment, and offering support to those we care about.
On the other hand, don’t worry if you don’t feel scared about discussing these things. In the early days of our friendship Fran was intensely manic and more or less constantly suicidal. Many people, including some who had known her a long time, were fearful and worried about her behaviour. I didn’t feel that way, but was unsure whether my ability to remain calm meant I was ill-equipped to support her effectively. I came to realise that my ability to remain calm made me the person she needed. As I wrote at the time, “[p]ositive, supportive and vigilant care is far healthier for Fran than any amount of fear-based worrying.”
Another reason we might hold back is the thought of being responsible for the person’s safety. I’ll cover suicide awareness and prevention training in the next section, but something I’ve learned from Fran and others is that not every conversation about suicide is a crisis situation. I think this fact is often overlooked. Holding space for someone to share their thoughts and feelings when they’re not actively suicidal is profoundly protective, not least because it demonstrates you’re someone they can feel safe with. We need to normalise talking about suicide because it’s such a common experience, and yet is so often stigmatised as dangerous and taboo, or solely the responsibility of professionals.
Of course, sometimes the person is actively suicidal and we need to be prepared for that possibility. One of the first things you’re taught in any suicide awareness or prevention training is that asking someone directly if they’re thinking of suicide won’t put the idea into their head or push them to do something they otherwise wouldn’t have done. If they say yes, ask if they’re planning to take action. If so, treat it seriously and be prepared to involve appropriate professional services if necessary. I’ve asked these questions on various occasions. Most times, the person wasn’t in immediate danger, and we’ve talked about what was going on for them and what steps they might take to stay safe. I’ve also called an ambulance for a friend who told me they’d taken an overdose and needed immediate medical assistance.
Being friends with someone who talks about wanting to die can be stressful, so remember to pay as close attention to your well-being as to theirs. Check out our article How to Take Care of Yourself When Your Friend is Suicidal for suggestions and tips.
Promoting Understanding and Empathy
As well as having private conversations, we can promote wider understanding and empathy in other ways. A good place to start is to be aware of the words we use when discussing suicide. The most obvious is to stop saying “committed suicide” and to challenge the term wherever we encounter it. A social media post by NAMI Bucks County PA puts the case powerfully.
People can die from the unbearable weight of life, people can die from broken hearts, and people can die from not understanding how to navigate a complicated mental health system. People do not, however, commit suicide. Suicide is not a crime. People die by suicide. Let’s update our language and fight to Improve our mental health system. Mental health support and improved access to better treatment IS suicide prevention.
For more on this check out Language Matters by the Public Health Agency of Canada and CNN’s article The words to say — and not to say — about suicide.
Reading or listening to other people’s experiences is another powerful route to understanding. My friend and fellow mental health blogger Aimee Wilson writes with great honestly about her lived experience including suicidality and self-harm at I’m NOT Disordered. Kevin Hines is an American suicide prevention speaker and author who attempted to take his life in 2000 by jumping from the Golden Gate Bridge in San Francisco. You can read his story on his website which links to a great deal of inspiring and educational content. Jonny Benjamin’s book The Stranger on the Bridge tells the story of finding himself on Waterloo Bridge in London in 2008 and his search to find the passing stranger who talked him down to safety. I met Jonny in 2019 at an event he attended with other speakers. You can read my account of the event in The Stranger on the Bridge and Other Stories of Friendship and Support.
There are also a number of excellent online courses on suicide awareness and prevention, many of which are free to take.
The single most important thing I’ve learned about suicidality is that it’s not the same for everyone and can take many forms. In our book we describe several ways suicidal thinking manifests for Fran. These include relentless thinking, situational and stress-induced thinking, hopelessness and despair, and suicide by proxy. All are serious, but they’re amenable to different forms of intervention. A change in medication dramatically decreased the frequency and impact of her relentless thoughts but had less impact on the other forms.
This isn’t unique to Fran. I’ve learned from other friends that coping strategies which counter some thoughts of suicidality and self-harm are ineffective in other situations. It’s not that the person isn’t trying hard enough to stay safe. The techniques available to them are simply not strong enough to counter the impulse to put their health, or their life, in danger. I can never truly understand what it’s like to be in such a situation but talking about it helps me appreciate that suicidality is never as black-and-white as it’s often portrayed.
Insight can be found in unexpected places. I recently came across a short video by Taylor Swift in which she talked about her song “This Is Me Trying.”
I’ve been thinking about people who, if they’re either suffering through mental illness, or they’re suffering through addiction, or they have an everyday struggle, no one pats them on the back every day but every day they are actively fighting something. But there are so many days that nobody gives them credit for that. And so how often must somebody who’s in that sort of internal struggle wanna say to everyone in the room “You have no idea how close I am to going back to a dark place.”
Keep your eyes and ears open when you’re online or talking with the people around you. Opportunities to grow, to learn, and to promote greater understanding are everywhere.
Navigating Sensitive Discussions with Empathy
Talking about suicide might be healthy and helpful, but what about the conversations themselves? What are they like? Our book High Tide, Low Tide contains many examples of our actual conversations, including times when Fran was suicidal. I’ve also written about this previously in What Does Having a Conversation about Mental Health Look Like? For now I’ll focus on two of the most important skills: not interrupting and asking questions.
Listening without interrupting is something I find particularly difficult, as Fran and other friends of mine can attest. The impulse to interrupt their story with suggestions and advice can be almost overwhelming. Interruptions are rarely appreciated, however. They can come across as me not paying attention, dismissing their concerns, or intervening with well-meaning but not necessarily helpful suggestions. Resist the temptation to say “I understand” unless you truly do have relevant lived experience. I’ve never had thoughts of suicide or self-harm, and although I’ve talked with many people who do, I’d never presume to know what it’s like to be in such a situation.
Asking questions might seem contradictory when I’ve just stressed not interrupting the person who’s talking, but asking the right questions at the right time in the right way is an important skill. The following passage from Sometimes We Need to Ask the Questions relates specifically to conversations about suicide and suicidal thinking.
Asking questions is not a passive activity. A question invites a response, and you may not get back what you anticipated or are comfortable with. [...] If your friend appears to be struggling, be prepared to ask the important questions.
Are you feeling suicidal, or thinking of doing something to harm yourself?
Do you feel you are safe right now?
Do we need to think about how to help you stay safe?
Also ask how your friend would like you to proceed if you become concerned for their safety. Respect their wishes and opinions, but be clear that you will involve other people or support services if necessary. That way you both know where you stand.
I was talking to a friend a few weeks ago about their recent experiences with mental health services. They mentioned that sometimes the crisis team was helpful and sometimes not. I was interested to know what advice or suggestions had helped. My question led to a valuable conversation about what my friend finds protective and what doesn’t work for them. I’ve had similar discussions with other friends. Such conversations increase my awareness of what my friends are going through. More importantly, they foster trust and normalise talking about things they live with on an ongoing basis.
As I wrote in Eight Things I’ve Learned about Suicidality and Self-Harm if you’ve never been in so dark a place, think about it this way. If there was something that was always or often in your mind, a part of your lived experience, and there was no one you could mention it to or talk to about it, how alone would you feel?
Further Reading and Resources
For more information and resources relating to World Suicide Prevention Day, suicide awareness, and suicide prevention, visit the International Association for Suicide Prevention, the World Health Organisation, Samaritans, and Grassroots Suicide Prevention.
We’ve shared a number of relevant articles over the years, including our curated list of posts for mental health awareness days and events, and a selection of articles for World Suicide Prevention Day.
Our resources page has links to international suicide crisis lines, support organisations, training resources, and books. UK mental health charity Mind offers a range of help and information if you need support or are concerned for someone else.
Photo by Etienne Boulanger at Unsplash.
